By Peter B. Cotton
The newest variation of the world-leading identify useful Gastrointestinal Endoscopy (published in could 2003) has a 'back to fundamentals' strategy - putting emphasis on perfecting the fundamental ideas of endoscopy. there's now a necessity for distinct sensible and medical courses to the complex endoscopy concepts for more matured physicians.
Advanced Digestive Endoscopy: ERCP addresses one of the most advanced diagnostic and healing techniques for endoscopists. It presents the newest pondering and transparent guide at the ideas, which were built-in with total sufferer care.
Written via the best overseas names in endoscopy, the textual content has been expertly edited through Peter Cotton right into a succinct, instructive structure. awarded in brief paragraphs dependent with headings, subheadings and bullet issues and richly illustrated all through with full-color pictures.
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Additional resources for Advanced Digestive Endoscopy - ERCP
It may be preferable to use the tip of the sphincterotome initially like a standard cannula for cannulation. When a change in axis is desired, the wire is then tightened (this is difﬁcult if the wire is still within the channel), lifting the tip of the sphincterotome in the axis of the bile duct. In addition, the sphincterotome is gently pushed out while advancing the tip of the scope further down into the second part of the duodenum. Sometimes sideways angulation is necessary to achieve a correct alignment with the axis of the bile duct.
If the cannula is seen to approach the papilla from the side, adjust the right or left angulation to put the papilla back into a central position. If the pancreatic duct is repeatedly cannulated, the tip of the cannula should be directed upwards towards the 11–12 o’clock position by advancing the scope further into the second part of the duodenum, so that the tip of the cannula approaches the papilla from below, and using the elevator to direct the cannula upwards in the axis of the CBD. Use the cannula to lift the roof of the papilla before attempting further insertion.
Vital signs including blood pressure, pulse, EKG, and oxygen saturation should be monitored continuously. Supplemental oxygen can be given via a nasal cannula at a ﬂow rate of FUNDAMENTALS OF ERCP 2 liters/min; this has been shown to prevent hypoxia. Care must be taken to avoid giving excess oxygen which may lead to respiratory depression in patients with COPD. Measuring the end-expiration CO2 level using capnography is carried out in some centers. Contrast agents The most commonly used contrast media such as conray 280, urograﬁn, hypaque, and renograﬁn contain iodine.